Provider Demographics
NPI:1326411901
Name:THE ENSPIRIT WELLNESS PROJECT
Entity Type:Organization
Organization Name:THE ENSPIRIT WELLNESS PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:MR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:ELISABETH
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:562-449-2676
Mailing Address - Street 1:20 FAIRBANKS
Mailing Address - Street 2:STE 180
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1624
Mailing Address - Country:US
Mailing Address - Phone:562-449-2676
Mailing Address - Fax:
Practice Address - Street 1:453 S SPRING ST
Practice Address - Street 2:SUITE 320
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-2013
Practice Address - Country:US
Practice Address - Phone:562-449-2676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12456171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty